Mucocelelike Lesions and Vacuum-Assisted Breast Biopsy: Advantages and Particularities

Abstract

AJR 2011; 196:W665 0361–803X/11/1965–W665 © American Roentgen Ray Society Mucocelelike Lesions and VacuumAssisted Breast Biopsy: Advantages and Particularities In an article in the American Journal of Roentgenology, Leibman et al. [1] provide interesting insight into mucocelelike lesions of the breast. We present our experience in comparison with the results of Leibman et al. In our setting, both vacuum-assisted breast biopsy (Mammotome, Ethicon Endo-Surgery, 11-gauge needle) and core biopsy (14-gauge needle) have been performed. According to the results of a double-blind study using vacuum-assisted breast biopsy, 24–96 cores were excised [2], yielding promising results regarding underestimation [3]. The diagnosis rate for mucocelelike lesions was 2.2% (15/693; 95% CI, 1.2– 3.5%) for vacuum-assisted breast biopsy, whereas the respective rate was 0.4% (3/857; 95% CI, 0.1–1.0%) for core biopsy. The observed vacuum-assisted breast biopsy superiority reached statistical significance (15/693 vs 3/857; p = 0.001, Fisher exact test). This finding supports the observation by Leibman et al. [1] underlining the importance of Mammotome biopsy in the diagnosis of mucocelelike lesions. Two (2/15; 13.3%; 95% CI, 1.7–40.5%) of the mucocelelike lesions diagnosed using vacuum-assisted breast biopsy harbored malignancy: one case of ductal carcinoma in situ and one case of invasive ductal carcinoma. The observed malignancy rate was relatively high, comparable to that reported by Leibman et al. [1]. In addition, one case (1/15; 6.7%; 95% CI, 0.2–31.9%) harbored a precursor lesion (lobular neoplasia). The postoperative diagnosis of lobular neoplasia was in accordance with the preoperative findings. The patients whose mucocelelike lesions were diagnosed as benign using vacuumassisted breast biopsy (12/15) underwent open surgery after hookwire localization. Interestingly, all of these lesions were proven benign after pathologic evaluation of the surgical specimen. This observation seems discrepant with that reported by Leibman et al. [1], who documented malignancy in one of four patients undergoing excisional biopsy after a benign diagnosis. That no such underestimated cases existed in our study may be due to the relatively larger number of cores excised in our setting. Unfortunately, Leibman et al. did not report the exact number of cores excised per lesion. Thus, no conclusive statement can be made. The three mucocelelike lesions revealed using core biopsy were all benign at both preoperative and postoperative evaluation. However, the small number of lesions does not allow us to draw any conclusions. In summary, mucocelelike lesions often may harbor carcinomas. For lesions diagnosed as benign using vacuum-assisted breast biopsy, excision of a larger number of cores may represent an alternative to the well-established excisional biopsy. Further studies are needed on the optimal diagnostic approach for mucocelelike breast lesions. George C. Zografos Flora Zagouri Theodoros N. Sergentanis Hippokratio Hospital University of Athens Athens, Greece DOI:10.2214/AJR.08.1161 WEB—This is a Web exclusive article.